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Suggest Treatment For Neck Pain In Infants

Posted on Fri, 13 Mar 2015

Question: My nephew is 5 yrs old. One fine morning he complained of pain in the side of the neck. After that he just keeps his head inclined to one side. While sleeping, all of a sudden he cries a lot with pain in the side of the neck and somewhere in head. In day time also if told to erect his neck he complains of pain in head. Since he is a kid the position and the kind of the pain he is unable to express. We visited neurologists but still the issue has not been rectified. This is the status for last 13 days. Seeking guidance in this regard.

Answered by Dr. Ajay Panwar (1 hour later)

Brief Answer:
It is likely an acquired torticollis(laterocollis).Need to work up for it.

Detailed Answer:
Hi Tajesh,
Thanks for being on healthcaremagic.com.

I have gone through the detailed medical reports you uploaded.
If your nephew would have presented to me as an outpatient,my clinical explanation would have been-
The clinical description given by you indicates that your nephew is likely having an acquired torticollis(laterocollis).Please upload an image of your nephew in the posture you described as it will help being precise for the clinical diagnosis.

Acquired laterocollis can result due to to the following conditions-
1)Postural abnormalities-keeping child in one particular posture for long periods
2)Some of the ENT related problems like tonsillitis,enlarged cervical lymph nodes,pharyngitis,some neck infection
3)Vertebral inflammation or spinal inflammation
4)Use of some drugs (Has he been on some medications prior to this?-Give any medicine details he has taken like for cold,vomiting,cough)
5)Dystonia-like wilson's disease(ceruloplasmin levels has been done in the reports you uploaded to rule out the same)
6)Idiopathic dystonia

I suggest the following in order to answer your query better-
1)Please upload the child's image as I mentioned
2)Neck and shoulder stretch exercises-Meet an expert physiotherapist for the same
3)Please consult an ENT surgeon

Waiting for your follow up question.

Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ajay Panwar (21 hours later)

Hi Dr. XXXXXXX

I have uploaded a pic of the kid.

BTW we have met physiotherapist already and the kid is doing light stretching exercises as well.

Awaiting your reply.

Answered by Dr. Ajay Panwar (4 hours later)

Brief Answer:
It is likely dystonia/laterocollis.

Detailed Answer:
Hi Tajesh,
Thanks for being in follow-up and uploading the picture.

It is dystonia of neck which is called torticollis(laterocollis).
Please tell drug history or medicines history,if any in the recent past?
Please visit an ENT surgeon for ruling out the causes discussed above.
Is there any family history of similar problem?
Meanwhile,please continue physiotherapy.
If the child do not show improvement after a couple of months of physiotherapy,he should be given a trial for anti-dystonia medicines.

Please follow-up with drug history details as some of the commonly used drugs are important cause of dystonia.

Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ajay Panwar (3 days later)

Hi Dr. XXXXXXX

Thanks for your answer.

These are the medicines related to cough and cold which the kid was taking. The number of days between last administration of these medicines and the start of the neck-problem is ~15 days.

Medicines are:
1. Ibugesicplus
2. Otostar eardrop
3. Syp Augmentin
4. Otrivin Nasal Drop

Your answer is awaited.

Thanks.

Answered by Dr. Ajay Panwar (6 hours later)

Brief Answer:
These medicines are not the likely culprit.

Detailed Answer:
Hi Tajesh,
Thanks for being in follow-up and providing the detailed drug history.

Is there any improvement with physiotherapy?Any new medicine started for dystonic posturing?

These medicines should not have caused the situation.That too,15 days later-no doubt that they have not caused it.

Continue physiotherapy.

Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Pradeep Vitta